Bisphosphonates after Denosumab withdrawal reduce the vertebral fractures incidence

Objective: Several studies showed the occurrence of vertebral fracture (VFx) in patients discontinuing denosumab (Dmab), suggesting the need of bisphosphonate (BPs) therapy to mitigate this VFx risk increase. However, the morphometric VFx (morphoVFx) incidence after Dmab discontinuation and the BPs effect on VFx risk in this setting are still a matter of debate. Design: Retrospective, monocentric study. Methods: In 120 patients (111 females) discontinuing Dmab, 19 have not been treated (Not-treated Group, 16 females, age 63.5±15.0 years) and 101 patients have been treated (Treated Group, 95 females, age 70.0±10.6 years) with BPs (28 alendronate, ALN; 73 zoledronate, ZOL, single infusion), respectively. We evaluated the incidence of both clinical VFx and morphoVFx in Treated Group and Non-treated Group. Results: Patients in Treated Group showed a 5.5% VFx incidence (n=6, 3 clinical, 3 morpho VFx), which was anyway lower than Not-treated Group patients (n=4, 21.1%, 4 clinical, 3 multiple, p=0.029), despite a comparable FRAX score at the time of Dmab initiation. The logistic regression analysis showed that the VFx incidence was independently associated with the lack of BPs treatment (odds ratio 13.9, 95% confidence interval 1.7-111.1, p=0.014), but not with the number of Dmab injections, age, duration of BPs before Dmab initiation, the BMD at Dmab withdrawal and the prevalence of VFx at Dmab withdrawal. Conclusions: The Dmab withdrawal is associated with an increased risk of clinical but not morphometric VFx. Therapy with ALN or with a single ZOL treatment are partially effective in reducing the increased VFx risk after Dmab withdrawal.

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Association between motoric cognitive risk syndrome and frailty among Chinese older adults

10.21203/rs.2.15390/v1 ◽

2019 ◽

Author(s):

Shanshan Shen ◽

Xingkun Zeng ◽

Liyu Xu ◽

Lingyan Chen ◽

Zixia Liu ◽

...

Keyword(s):

Older Adults ◽

Logistic Regression ◽

Regression Analysis ◽

Confidence Interval ◽

Logistic Regression Analysis ◽

Odds Ratio ◽

Cognitive Complaints ◽

Chinese Older Adults ◽

Cognitive Risk ◽

Subjective Cognitive Complaints

Abstract Background: Motoric cognitive risk syndrome (MCR) is a newly proposed pre-dementia syndrome incorporating subjective cognitive complaints and slow gait. Previous studies have shown that subjective cognitive complaints and slow gait are reported to be associated with frailty in cognitively unimpaired older adults, but little is known giving attention to the link between MCR and frailty in older adults. Therefore, the aim of the study was to explore the associations of MCR and its components and frailty in Chinese older adults. Methods: In an observation cross-sectional study, a total of 429 older adults aged 60 years and older were admitted to the geriatric department. According to MCR criteria, all participants were classified to 4 groups: 1) MCR group; 2) subjective cognitive complaints group; 3) slow gait group; 4) healthy control group. Physical frailty was assessed by Clinical Frailty Scale (CFS). The multivariate logistic regression analysis was used to examine the association between MCR and frailty in older adults. Results: The prevalence of subjective cognitive complaints, slow gait and MCR was 15.9%, 10.0% and 4.0%, respectively. After adjusting for confounding variables, the logistic regression analysis showed that slow gait (odds ratio [OR] 3.40, 95% confidence interval [CI] 1.40-8.23, P=0.007) and MCR (odds ratio [OR] 5.53, 95% confidence interval [CI] 1.46-20.89, P=0.012) were independently associated with frailty, but not subjective cognitive complaints. Conclusions: MCR and slow gait were significantly associated with frailty in Chinese older adults. Further study should prospectively determine the causal relationship between MCR and frailty.

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Association Between Use of Preoperative Antihypertensive Medication and 90-Day Mortality After Noncardiac Surgery: A Retrospective Cohort Study

American Journal of Hypertension ◽

10.1093/ajh/hpaa012 ◽

2020 ◽

Vol 33 (6) ◽

pp. 534-542

Author(s):

Chami Im ◽

Tak Kyu Oh ◽

In-Ae Song

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Cohort Study ◽

Confidence Interval ◽

Retrospective Cohort Study ◽

Odds Ratio ◽

Retrospective Cohort ◽

Antihypertensive Medication ◽

Noncardiac Surgery ◽

Hypertensive Patients

Abstract Background This study aimed to determine whether use of preoperative antihypertensive medication is associated with postoperative 90-day mortality in the hypertensive adult population that underwent elective noncardiac surgery. Methods In this retrospective cohort study, medical records of preoperative hypertensive patients who underwent noncardiac surgery at a single tertiary academic hospital from 2012 to 2018 were reviewed. Among the hypertensive patients, those prescribed to take antihypertensive medication continuously for more than 1 month before admission were defined as the HTN MED group; others were defined as the non-HTN MED group. Multiple imputation, propensity score (PS) matching, and logistic regression analysis were used for statistical analysis. Results Overall, 35,589 preoperative hypertensive adult patients (HTN MED group: 26,154 patients, non-HTN MED group: 9,435 patients) were included in the analysis. After PS matching, each group comprised 6,205 patients; thus, 12,410 patients were included in the final analysis. The odds for 90-day mortality of the HTN MED group in the PS-matched cohort were 41% lower (odds ratio: 0.59, 95% confidence interval: 0.41–0.85; P = 0.005) than those of the non-HTN MED group. Comparable results were obtained in the multivariable logistic regression analysis of the entire cohort (odds ratio: 0.54, 95% confidence interval: 0.41–0.72; P < 0.001). Conclusions This study showed that the use of preoperative antihypertensive medication was associated with lower 90-day mortality among hypertensive patients who underwent noncardiac surgery. Therefore, preoperative screening and treatment with appropriate antihypertensive medication are important for hypertensive patients.

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Neuraxial analgesia is not associated with an increased risk of post-partum relapses in MS

Multiple Sclerosis Journal ◽

10.1177/1352458518763080 ◽

2018 ◽

Vol 25 (4) ◽

pp. 591-600 ◽

Cited By ~ 4

Author(s):

Caroline Lavie ◽

Fabien Rollot ◽

Françoise Durand-Dubief ◽

Romain Marignier ◽

Iuliana Ionescu ◽

...

Keyword(s):

Multiple Sclerosis ◽

Logistic Regression ◽

Regression Analysis ◽

Odds Ratio ◽

Post Partum ◽

Neuraxial Analgesia ◽

Increased Risk ◽

Obstetrical Analgesia ◽

The Impact ◽

Risk Of Relapse

Background: Obstetrical analgesia remains a matter of controversy because of the fear of neurotoxicity of local anesthetics on demyelinated fibers or their potential relationship with subsequent relapses. Objective: To assess the impact of neuraxial analgesia on the risk of relapse during the first 3 months post-partum, with a focus on women who experienced relapses during pregnancy. Methods: We analyzed data of women followed-up prospectively during their pregnancies and at least 3 months post-partum, collected in the Pregnancy in Multiple Sclerosis (PRIMS) and Prevention of Post-Partum Relapses with Progestin and Estradiol in Multiple Sclerosis (POPARTMUS) studies between 1992–1995 and 2005–2012, respectively. The association of neuraxial analgesia with the occurrence of a post-partum relapse was estimated by logistic regression analysis. Results: A total of 389 women were included, 215 from PRIMS and 174 from POPARTMUS. In total, 156 women (40%) had neuraxial analgesia. Overall, 24% experienced a relapse during pregnancy and 25% in the 3 months post-partum. Women with a pregnancy relapse were more likely to have a post-partum relapse (odds ratio (OR) = 1.83, p = 0.02), independently of the use of neuraxial analgesia. There was no association between neuraxial analgesia and post-partum relapse (OR = 1.08, p = 0.78). Conclusion: Neuraxial analgesia was not associated with an increased risk of post-partum relapses, whatever multiple sclerosis (MS) activity during pregnancy.

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Abstract WP220: The Effect of Self-Reported Optimism on the Incidence of Stroke

Stroke ◽

10.1161/str.48.suppl_1.wp220 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Ahmed Malik ◽

Haseeb Rahman ◽

Adnan Qureshi ◽

Martha A Wojtowycz

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Regression Analysis ◽

Standard Deviation ◽

Confidence Interval ◽

Stroke Prevention ◽

Odds Ratio ◽

Categorical Variables ◽

The Mean ◽

Baseline Characteristics

Purpose: The purpose of this study is to determine whether having an optimistic outlook on life decreases the risk of developing incident stroke. Methods: Participants who developed incident stroke in Americans’ Changing Lives study, and participants who did not develop incident stroke (dependent variable) in were compared for demographics, baseline characteristics, comorbidities, and optimistic outlook on life. Numbers and proportions of respondents in both groups were reported for all categorical variables, while mean and standard deviation were reported for age. All statistically significant variables from the above analyses were entered into a logistic regression analysis to ascertain the association between optimistic outlook on life and stroke. Results: Of the 98,577,928 participants, 73,040,055 did not have stroke at baseline. There were 599,190 who developed incident stroke and 1,104,751 who did not develop incident stroke. The mean age (standard deviation) was lower in those who developed incident stroke compared to those who did not [45.9 (13.8) vs. 46.4 (9.9) p<.0001], and participants with an optimistic outlook on life, were 0.20 times less likely to develop stroke as those who did not have an optimistic outlook on life [OR (Odds ratio) 0.20 95% CI (95% confidence interval) 0.20,0.21], after adjusting for confounders. Conclusions: People who have an optimistic outlook on life are less likely to develop incident stroke. The protective value of optimism lends credence to the value of targeting unconventional risk factors in stroke prevention.

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Perioperative ABO Blood Group Isoagglutinin Titer and the Risk of Acute Kidney Injury after ABO-Incompatible Living Donor Liver Transplantation

Journal of Clinical Medicine ◽

10.3390/jcm10081679 ◽

2021 ◽

Vol 10 (8) ◽

pp. 1679

Author(s):

Hyeyeon Cho ◽

Jinyoung Bae ◽

Hyun-Kyu Yoon ◽

Ho-Jin Lee ◽

Seong-Mi Yang ◽

...

Keyword(s):

Liver Transplantation ◽

Acute Kidney Injury ◽

Logistic Regression ◽

Regression Analysis ◽

Confidence Interval ◽

Odds Ratio ◽

Kidney Injury ◽

Multivariable Logistic Regression Analysis ◽

Ig G ◽

Postoperative Aki

For ABO-incompatible liver transplantation (ABO-i LT), therapeutic plasma exchange (TPE) is performed preoperatively to reduce the isoagglutinin titer of anti-ABO blood type antibodies. We evaluated whether perioperative high isoagglutinin titer is associated with postoperative risk of acute kidney injury (AKI). In 130 cases of ABO-i LT, we collected immunoglobulin (Ig) G and Ig M isoagglutinin titers of baseline, pre-LT, and postoperative peak values. These values were compared between the patients with and without postoperative AKI. Multivariable logistic regression analysis was used to evaluate the association between perioperative isoagglutinin titers and postoperative AKI. Clinical and graft-related outcomes were compared between high and low baseline and postoperative peak isoagglutinin groups. The incidence of AKI was 42.3%. Preoperative baseline and postoperative peak isoagglutinin titers of both Ig M and Ig G were significantly higher in the patients with AKI than those without AKI. Multivariable logistic regression analysis showed that preoperative baseline and postoperative peak Ig M isoagglutinin titers were significantly associated with the risk of AKI (baseline: odds ratio 1.06, 95% confidence interval 1.02 to 1.09; postoperative peak: odds ratio 1.08, 95% confidence interval 1.04 to 1.13). Cubic spline function curves show a positive relationship between the baseline and postoperative peak isoagglutinin titers and the risk of AKI. Clinical outcomes other than AKI were not significantly different according to the baseline and postoperative peak isoagglutinin titers. Preoperative high initial and postoperative peak Ig M isoagglutinin titers were significantly associated with the development of AKI. As the causal relationship between high isoagglutinin titers and risk of AKI is unclear, the high baseline and postoperative isoagglutinin titers could be used simply as a warning sign for the risk of AKI after liver transplantation.

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Serum IgG4 Levels at Diagnosis Can Predict Unfavorable Outcomes of Untreated Patients With IgG4-related Disease: A Japanese Single-Center Retrospective Study

10.21203/rs.3.rs-394250/v1 ◽

2021 ◽

Author(s):

Ichiro Mizushima ◽

Masahiro Konishi ◽

Hajime Sanada ◽

Kazuyuki Suzuki ◽

Akari Takeji ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Confidence Interval ◽

Clinical Features ◽

Logistic Regression Analysis ◽

Odds Ratio ◽

Laboratory Data ◽

Single Center ◽

Igg4 Related Disease ◽

Serum Igg4

Abstract Background The outcomes of patients with IgG4-RD who are not treated are unclear. This study aimed to clarify these outcomes and identify the factors related to them. Methods We retrospectively evaluated various clinical features including laboratory data and involved organs at diagnosis in 107 patients with IgG4-RD, who were followed up for more than 6 months, at a single center in Japan. We compared the clinical features of the 27 untreated patients with those of the 80 patients treated with glucocorticoid. The patient outcomes were investigated, and logistic regression analysis was performed to identify factors related to them. Results The patients comprised 73 men and 34 women (median age 67 years). The untreated patients had significantly lower IgG4-RD responder index (9 vs 12) and fewer affected organs (1 vs 3) than did those treated with glucocorticoid. Of these 27 patients, 8 experienced deterioration of IgG4-RD after the diagnosis. In the age- and sex-adjusted logistic regression analysis, serum IgG4 elevation (per 100 mg/dL, odds ratio 1.194, 95% confidence interval 1.017–1.402) was the only significant factor related to disease deterioration in untreated patients with IgG4-RD, whereas not serum IgG4 levels (per 100 mg/dL, odds ratio 0.995, 95% confidence interval 0.921–1.075) but history of allergy (OR 3.134, 95% confidence interval 1.094–8.977, P = 0.033) related to deterioration in patients who underwent treatment. Conclusions Serum IgG4 levels may be a useful predictor of unfavorable outcomes in untreated patients with IgG4-RD, who tend to have fewer affected organs and lower IgG4-RD responder index.

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Safety and Feasibility Analysis of Laparoscopic Lymphadenectomy in Pelvic Gynecologic Malignancies: A Prospective Study

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000555 ◽

2015 ◽

Vol 25 (9) ◽

pp. 1704-1710 ◽

Cited By ~ 12

Author(s):

Virginia Benito ◽

Silvia Romeu ◽

Miriam Esparza ◽

Sonia Carballo ◽

Octavio Arencibia ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Adverse Events ◽

Confidence Interval ◽

Logistic Regression Analysis ◽

Odds Ratio ◽

Gynecologic Oncology ◽

Pelvic Lymphadenectomy ◽

Factors Associated ◽

Surgical Adverse Events

ObjectiveThe aims of this study were to evaluate prospectively the safety and feasibility of laparoscopic lymphadenectomy in gynecologic oncology and to analyze risk factors associated with surgical adverse events.Materials and MethodsThis study included 444 consecutive laparoscopic lymphadenectomy procedures conducted in 358 consecutive gynecologic oncology patients, between 2007 and 2014. Surgical adverse events were classified into intraoperative, early postoperative (≤6 weeks after surgery), and late postoperative (>6 weeks after surgery). Logistic regression analysis was used to assess the independent effects of different variables on the probability of complications. Differences were considered to be statistically significant for P values less than 0.05.ResultsTwo hundred forty-four pelvic lymphadenectomy and 200 aortic lymphadenectomy procedures were carried out during the studied period. All pelvic lymphadenectomy procedures were conducted with a transperitoneal approach, whereas 94.5% of aortic lymphadenectomy procedures were conducted with an extraperitoneal approach. A total of 52.2% of tumors were found to originate in the cervix, 38% in the endometrium, 6.4% in the ovary, 2.8% were sarcoma, and 0.6% were in a different region. The laparotomy conversion rate was 2.8%. The rate of intraoperative adverse events was 1.9%, the most frequent ones being vascular injuries followed by ureteral, bowel, or neurologic injuries. The rate of early-postoperative adverse events was 3.3%, the most frequent one being incisional hernia followed by hemoperitoneum, pelvic abscess, intestinal injury, and paralytic ileus. One patient with endometrial cancer died after surgery due to sepsis of unknown origin. The rate of late-postoperative adverse events was 3.6% and consisted mainly of symptomatic lymphocele or lymphedema. A logistic regression analysis showed that factors associated with increased risk of lymphadenectomy surgical complications were surgical bleeding and operative time (odds ratio, 2.6; 95% confidence interval, 1.1–6; P = 0.02 and odds ratio, 2.6; 95% confidence interval, 1–6.7; P = 0.04).ConclusionsLaparoscopic lymphadenectomy is a safe and feasible procedure in gynecologic oncology but not free of complications. We postulate that gynecologic oncologists should be properly trained in the management of such complications and be aware of the importance of adequate hemostasis and operating time during surgery.

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Symptoms from repeated intentional and unintentional head impact in soccer players

Neurology ◽

10.1212/wnl.0000000000003657 ◽

2017 ◽

Vol 88 (9) ◽

pp. 901-908 ◽

Cited By ~ 37

Author(s):

Walter F. Stewart ◽

Namhee Kim ◽

Chloe S. Ifrah ◽

Richard B. Lipton ◽

Tamar A. Bachrach ◽

...

Keyword(s):

Logistic Regression ◽

Confidence Interval ◽

Repeated Measures ◽

Odds Ratio ◽

Soccer Players ◽

Single Exposure ◽

Head Impacts ◽

Increased Risk ◽

On Line ◽

Differential Contribution

Objective:To determine the rate and differential contribution of heading vs unintentional head impacts (e.g., head to head, goal post) to CNS symptoms in adult amateur soccer players.Methods:Amateur soccer players completed baseline and serial on-line 2-week recall questionnaires (HeadCount) and reported (1) soccer practice and games, (2) heading and unintentional soccer head trauma, and (3) frequency and severity (mild to very severe) of CNS symptoms. For analysis, CNS symptoms were affirmed if one or more moderate, severe, or very severe episodes were reported in a 2-week period. Repeated measures logistic regression was used to assess if 2-week heading exposure (i.e., 4 quartiles) or unintentional head impacts (i.e., 0, 1, 2+) were associated with CNS symptoms.Results:A total of 222 soccer players (79% male) completed 470 HeadCount questionnaires. Mean (median) heading/2 weeks was 44 (18) for men and 27 (9.5) for women. One or more unintentional head impacts were reported by 37% of men and 43% of women. Heading-related symptoms were reported in 20% (93 out of 470) of the HeadCounts. Heading in the highest quartile was significantly associated with CNS symptoms (odds ratio [OR] 3.17, 95% confidence interval [CI] 1.57–6.37) when controlling for unintentional exposure. Those with 2+ unintentional exposures were at increased risk for CNS symptoms (OR 6.09, 95% CI 3.33–11.17) as were those with a single exposure (OR 2.98, 95% CI 1.69–5.26) when controlling for heading.Conclusions:Intentional (i.e., heading) and unintentional head impacts are each independently associated with moderate to very severe CNS symptoms.

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Smoking as a risk factor for multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458512470862 ◽

2012 ◽

Vol 19 (8) ◽

pp. 1022-1027 ◽

Cited By ~ 34

Author(s):

Jonatan Salzer ◽

Göran Hallmans ◽

Maria Nyström ◽

Hans Stenlund ◽

Göran Wadell ◽

...

Keyword(s):

Multiple Sclerosis ◽

Logistic Regression ◽

Risk Factor ◽

Confidence Interval ◽

Tobacco Use ◽

Odds Ratio ◽

Disease Onset ◽

Recall Bias ◽

Blood Samples ◽

Increased Risk

Background: Smoking has been associated with an increased risk for multiple sclerosis, but no studies have measured levels of the nicotine metabolite cotinine in prospectively collected samples to assess exposure. Objective: To investigate the effects of laboratory defined tobacco use on the risk for multiple sclerosis using prospectively collected biobank blood samples. Methods: Levels of cotinine were measured in n=192 cases, and n=384 matched controls, using an immunoassay. The risk for multiple sclerosis was estimated using matched logistic regression. Results: Elevated cotinine levels (≥10 ng/ml) were associated with a significantly increased risk for multiple sclerosis, (odds ratio, OR 1.5, 95% confidence interval, CI 1.0–2.1). This association was only present in young individuals (below median age at blood sampling, <26.4 years), (OR 2.2, 95% CI 1.3–3.8). Conclusions: This study confirms that smoking is a risk factor for multiple sclerosis. It has the advantage of using analyses of cotinine levels in samples that were collected several years before disease onset, thus excluding any risk for recall bias and minimising the risk for reversed causation. Our results also suggest that the smoking related immunological events that contribute to the development of multiple sclerosis occur early in life.

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Association between motoric cognitive risk syndrome and frailty among Chinese older adults

10.21203/rs.2.15390/v2 ◽

2019 ◽

Author(s):

Shanshan Shen ◽

Xingkun Zeng ◽

Liyu Xu ◽

Lingyan Chen ◽

Zixia Liu ◽

...

Keyword(s):

Older Adults ◽

Logistic Regression ◽

Regression Analysis ◽

Confidence Interval ◽

Logistic Regression Analysis ◽

Odds Ratio ◽

Cognitive Complaints ◽

Chinese Older Adults ◽

Cognitive Risk ◽

Subjective Cognitive Complaints

Abstract Background: Motoric cognitive risk syndrome (MCR) is a newly proposed pre-dementia syndrome incorporating subjective cognitive complaints and slow gait. Previous studies have shown that subjective cognitive complaints and slow gait are reported to be associated with frailty in cognitively unimpaired older adults, but little is known giving attention to the link between MCR and frailty in older adults. Therefore, the aim of the study was to explore the associations of MCR and its components and frailty in Chinese older adults. Methods: In an observation cross-sectional study, a total of 429 older adults aged 60 years and older were admitted to the geriatric department. According to MCR criteria, all participants were classified to 4 groups: 1) MCR group; 2) subjective cognitive complaints only group; 3) slow gait only group; 4) healthy control group. Physical frailty was assessed by Clinical Frailty Scale (CFS). The multivariate logistic regression analysis was used to examine the association between MCR and frailty in older adults. Results: The prevalence of subjective cognitive complaints, slow gait and MCR was 15.9%, 10.0% and 4.0%, respectively. After adjusting for confounding variables, the logistic regression analysis showed that slow gait (odds ratio [OR] 3.40, 95% confidence interval [CI] 1.40-8.23, P=0.007) and MCR (odds ratio [OR] 5.53, 95% confidence interval [CI] 1.46-20.89, P=0.012) were independently associated with frailty, but not subjective cognitive complaints. Conclusions: MCR and slow gait were significantly associated with frailty in Chinese older adults. Further study should prospectively determine the causal relationship between MCR and frailty.

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